METHOD FOR SURGICAL RECONSTRUCTION OF STERNUM AFTER RESECTION IN MALIGNANT TUMOUR USING COMBINED INDIVIDUAL IMPLANT Russian patent published in 2024 - IPC A61B17/56 A61F2/28 A61B17/80 

FIELD: medicine.

SUBSTANCE: method for surgical reconstruction of the sternum after resection in a malignant tumour is characterized by the fact that a combined implant is used for surgical replacement of the removed malignant tumour of the chest. Before performing the surgical treatment, a spatial imaging of the patient's sternum lesions and intact bone tissues is determined by multilayer spiral computed tomography, magnetic resonance imaging is used to assess the state of surrounding soft tissues, vascular and nerve structures not visualized when performing multilayer spiral computed tomography. Performing based on results of multilayer spiral computed tomography of anatomical features of structure of patient's sternum with displayed oncologically affected bone anatomical structures virtual planning of stages of surgical reconstruction of patient’s thorax bone anatomy with virtual determination of volume of resection of malignant tumour of sternum. Then, virtual preoperative planning of the shape and volume of the combined implant is performed for the surgical replacement of the removed malignant tumour of the chest, at that, virtually forming a flat and curved body with curved plate elements in the form of processes for fixation to the I and II pairs of ribs, to the bone structures of the sternum body and to the clavicles, wherein on the body of the combined implant and on the plate fixation elements, holes are virtually formed for placement of cortical fixing screws with a blocking diameter of 3.5 mm in number of 3 holes for fixation to clavicle, 2 holes for fixation to ribs and 4 holes for fixation to sternum, simultaneously, all fixation holes are virtually duplicated with holes for planned lavsan or vicryl filament cerclages by preliminary fixation of combined implant to bone structures of sternum. Virtual model of the combined implant body is virtually equipped with two connecting sleeves with ball-shaped elements of the movable joint with plate curved elements for surgical fixation of the body of the combined implant to the clavicles through fixing holes made on the plate curved elements. Then, elements of the combined implant from titanium alloy and polyethylene are printed on the basis of the executed virtual project. Combined implant body with fixing plate elements, as well as fixing screws are made of titanium alloy, and two connecting sleeves are made of polyethylene, and perform their preoperative assembly. After performing the anaesthesia care with the patient lying on his/her back, the malignant tumour of the sternum is approached. Pectoral muscles are mobilized and moved apart. Anterior neoplasm, a sternum body, clavicle, I and II pairs of ribs are separated, above the III rib on the left and on the right, the pleura is bluntly exfoliated. Sternotome is introduced through the formed canal and the sternum is transected. Segmental resection of cartilaginous part of I and II pairs of ribs is performed. Sternoclavicular joints are transected on the left and on the right. Sternocleidomastoid muscle is cut off on the left and on the right. Sternum handle with a malignant tumour is mobilized from the pleura. Fragment with malignant tumour is removed ventrally. Soft tissues are mobilized. Sternum handle with a malignant tumour is removed as a single block. In preparation for prosthetics, resection of the medial part of clavicles is carried out for 1 cm. Before placing the pre-assembled combined implant in the resection zone, its bent plate elements of the connection with the clavicles are latched in each ball-shaped connecting sleeve with the ball-shaped elements of the movable connection. Finally assembled combined implant is placed in the area of the resected malignant tumour and performing its preliminary fixation to bone structures of sternum by stitching with lavsan or vicryl filament cerclages through holes made on the body of the combined implant and on the plate fixation elements. Final fixation of the body and plate fixation elements of the combined implant is performed to the bone structures of the sternum, to the I and II pairs of ribs and to the patient's clavicles with locking cortical screws. Functional test of stability of fixation of combined implant and preservation of movements in sternoclavicular joint is performed. Combined implant is closed with muscles; the sternum-clavicle-mastoid muscles are anchored to the combined implant and to the soft tissues of the pectoral muscles adjacent to the implant. Patient is activated on 5th day in Delbe's rings to stabilize the shoulder girdle. On 14th day, the patient is discharged for outpatient follow-up at the place of residence.

EFFECT: invention provides reliable preservation of chest frame, support ability of sternoclavicular joint with preservation of anatomical function of upper shoulder girdle, possibility of performing preoperative planning of surgical reconstruction of a sternum handle after its extensive resection in a malignant tumour with a combined implant, as well as significant improvement of patient’s quality of life.

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